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Essure Reversal
Explained in Detail

Most health care providers are unaware Essure can be reversed. The reality is Essure can be reversed and natural pregnancy is possible.

Essure causes the fallopian tubes to become blocked at the very beginning of the tube. The beginning of the tube is often referred to as the proximal (closest to the uterus) portion of the tube. Blockage of the proximal portion of the fallopian tube can be surgically corrected. The historical gold standard procedure for the surgical correction of proximal tubal blockage is a tubouterine implantation. Most people, including health care providers, are unaware the first successful surgery to reverse proximal occlusion of the fallopian tubes occurred in the early 1900’s!

Before we ever performed our first Essure reversal surgery, we had been performing tubouterine implantation for the reversal of proximal tubal occlusion from other types of tubal ligation.

Tubouterine implantation
An uncommon reversal technique

Most infertility specialists do not perform tubal ligation reversal and even less will perform tubouterine implantation.

Tubouterine implantation is much different than other types of tubal reversal procedures because it requires deep incisions be made into the uterine muscle. This will often increase the risk of surgery. Most doctors either don’t have the training to perform this specialized repair procedure or the awareness the surgery can safely be performed as an outpatient procedure.

We have been doing this for years and have a high degree of comfort with this type of reversal technique in the outpatient setting.

Tubouterine implantation
A Long history

Tubouterine implantation was performed in the late19th century. The first reports of tubal implantation were in European Journals and were very limited in description and success rate. Dr. Turck described the first successful tubouterine implantation resulting in pregnancy in 1909 in the New York Medical Journal.

The first modern reports of tubouterine implantation indexed in PubMed begin to appear in the 1950’s. Tubouterine implantation was then performed with more frequency in the 1960’s and 1970’s and was found to have pregnancy success rates as high as 60%. In the 1980’s IVF, became more popular and tubal ligation reversal surgery, as well as tubouterine implantation, began to be performed less often. This is the reason most doctors are unfamiliar with many of the techniques of tubal repair surgery.

Many of todays doctors have never seen the procedure and are not even aware tubouterine implantation is possible or can provide a reasonable chance of pregnancy success. Although the American Society for Reproductive Medicine supports tubal ligation reversal surgery, these infertility experts are of the position tubouterine implantation is of historical interest only.

We have had success with tubouterine implantation and have observed success rates similar to a single cycle of IVF with this type of tubal repair procedure. We have found with the introduction of the ‘newer’ Essure sterilization procedure that a ‘historical’ tubal repair procedure has found a new indication for use.

How do we reverse Essure?

The Essure reversal procedure is performed under general anesthesia and can often be performed in less than 90 minutes. We attempt to use as small of an incision as possible and often we will make a 4 to 5 inch incision over the pubic hairline. Even our largest incision is smaller than the average Cesarean delivery incision.

The Essure devices are visualized where they exit from the uterus and in the very beginning of the fallopian tube. An incision is made into the tube and over the ends of the Essure devices. The Essure devices are then dissected away from the uterus intact and with the surrounding scar tissue. The remaining healthy fallopian tubes are then introduced into newly created openings and each tube is securely sutured into place. Often blood loss is minimal and patients will recover in our recovery room in less than one hour before they are ready to return to the hotel.

Patients return to the office the day after their procedure for evaluation. Essure reversal patients are advised they can attempt to become pregnant after their next menstrual cycle and they can return to limited work duties within the next two weeks. Patients are asked not to lift anything heavier than 15 lbs. for the first month after surgery. If heavy lifting is required at work then patients are asked to wait 4 weeks before returning to strenuous activity.

Most patients who become pregnant will do so within the first year.

Risks of Essure reversal surgery

In our experience, we have found Essure reversal to be a safe outpatient surgery. The main risk of Essure reversal is the increased risk of rupture of the uterus with future pregnancy. A uterine rupture is when the previous incision on the uterus tears during the later stages of pregnancy.

Why does uterine rupture happen?

Any incision made in the uterine muscle can increase the risk of a uterine rupture in future pregnancy. Previous Cesarean delivery is the single most common reason a rupture of the uterus will occur. The area where the incision was made can potentially become a source of weakness when stretched by a third trimester pregnancy and exposed to the forces of labor contractions.

Past medical literature on tubouterine implantation suggest uterine rupture is a risk of the tubouterine implantation procedure. For ultimate patient safety, we recommend a Cesarean delivery before the due date in any future pregnancy after Essure reversal. It is unclear what the exact risk of rupture of the uterus is after Essure reversal but we estimate it is likely less than 10%.

Most of our patients have followed our recommendations and none of our patients have reported rupture of the uterus as a complication of Essure reversal.

Are other Essure reversal techniques safer?

Some surgeons advocate surgical techniques other than tubouterine implantation for Essure reversal and imply these techniques have a lower risk of uterine rupture than tubouterine implantation. There is no supportive medical literature which demonstrates other techniques have either resulted in pregnancy after Essure reversal or have a lower risk of uterine rupture. Until adequate medical studies are published assertions other Essure reversal techniques have a lower risk of rupture are speculative.

For the optimal safety of both mom and baby, we recommend an elective Cesarean delivery before the estimated due date for any pregnancy after Essure reversal.

Medical Literature

1. Normal pregnancy after outpatient tubouterine implantation in patient with Adiana sterilization
Monteith, Charles W. MD; Berger, Gary S. MD, MPH, Fertil Steril: July 2011 – Volume 98 – Issue Part 1 – pages e45-e46

2. Successful Pregnancies After Removal of Intratubal Microinserts
Monteith, Charles W. MD; Berger, Gary S. MD, MPH, Obstetrics & Gynecology: February 2012 – Volume 119 – Issue Part 2 – p 470–472

3. Pregnancy Success After Hysteroscopic Sterilization Reversal
Monteith, Charles W. MD; Berger, Gary S. MD; Zerden, Matthew L. MD, MPH, Obstetrics & Gynecology: December 2014 – Volume 124 – Issue 6 – p 1183–1189

57 thoughts on “Essure Reversal: Explained in Detail”

  1. J. says:

    I am 33. I had Essure done 10 years ago and an ablation done 3 years ago- (my periods came back within 6 months after the ablation)
    I also have some small fibroids. My husband and I decided we wanted to have a baby- what are my chances of conceiving?

    1. Dr. Monteith says:

      In general it is recommended that you not become pregnant after having an ablation procedure.

      Tubal reversal and pregnancy are possible if you are having regular periods of at least 3 days duration after your ablation. All pregnancies after ablation are considered high risk. Most IVF doctors will recommend using a gestational surrogate. IVF costs average $14,000 and you will have to pay the surrogate even more.

      If you are not having periods then we would not consider you a candidate for reversal. There is no medical treatment to make your periods return.

      Ablation will decrease the chance of pregnancy because it permanently damages the lining and muscle of the uterus.

      If your periods are light then you do have some functioning endometriumm but we are not always certain if it is enough to allow for pregnancy. There is no accurate way to be certain.

      We cannot provide an accurate percentage about the success of women getting pregnant after reversal with a prior ablation because there are no large scale studies looking at this. We have had women become pregnant naturally after tubal reversal with a prior ablation but don’t have a large enough group of these patients to provide meaningful statistics.

      Studies looking at women who have become pregnant after ablation show that about 50% will miscarry and about 50% will have live born babies.

      You should read these six articles I wrote about ablation, reversal, and the risks of pregnancy: Tubal Reversal and Ablation

      The ablation will decrease the chances of pregnancy but if you are having regular monthly periods of at least three days duration then pregnancy is certainly possible. If you are not having regular periods then I would advise against a reversal because pregnancy is not likely.

      In general pregnancy is not recommended after ablation because each pregnancy is at higher risk; miscarriage, growth restriction, early delivery, c-section and adherent placenta. The literature suggest that pregnancies are high risk but many will do well. It is possible to become pregnant after tubal reversal and have a healthy pregnancy if you are having regular periods of at least three days duration every month. Please call us at (919)977-5050 if you have any additional questions about tubal reversal.

      All patients with ablations need a consult with me (Dr Monteith) either by phone or in person before they can schedule reversal surgery.

  2. Anonymous says:

    Would it be possible to prepay BEFORE scheduling appointment? For example, if I wanted the surgery say a year & a half from now could I make payments now until it’s paid in full and THEN schedule appointment?

    1. Dr. Monteith says:

      You can prepay and that would be our Prepayment plan….you have 3 years to complete your surgery once the plan is opened. You have to open your plan with at least $500. As a plan member we email you about discounted surgery rates when these discounted rates are available. Call us at (919)968-4656 and we can speak to you more about this

    2. Dr. Monteith says:

      Our number was incorrect in the last message. Call us (919)968-4656 for more information.

  3. Kasey says:

    I have a few questions. I’m thinking about having my coils removed to get pregnant. Can you send me information. I wanted to know if you pay the whole amount, or can make payments. Thanks!

    1. Dr. Monteith says:

      Most patents pay in full at the time of surgery. Some patients start a prepayment plan and others will finance surgery. We do not allow patients to make payments after surgery is complete.

      We specialize in Essure reversal and Essure removal. No other clinic or doctor has the experience we do. The chance of pregnancy after Essure reversal is about 40%.

      More information: Successful Essure reversal with Dr Monteith

      We charge a total of $7,500 for Essure reversal/removal plus $125 to schedule surgery. We do work with two financing companies and we do have a prepayment plan.

      Here is more information on the Tubal Reversal Prepayment Account: Tubal Reversal Prepayment Account

      Here is more information on tubal reversal financing: Tubal Reversal Financing

      Call us at (919) 968-4656 8am to 5pm eastern standard time and we would be happy to speak with you.

      The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal

  4. Teala says:

    Just need the address and this cost of the procedure I’ve been suffering for 2yrs need help please and thank you in advance

    1. Dr. Monteith says:

      We are in Raleigh, North Carolina. We charge a total of $6400 plus $125 to schedule. Call us at (919) 968-4656 8am to 5pm eastern standard time and we would be happy to speak with you.

      The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal

  5. Melissa says:

    What is your waiting list like

    1. Dr. Monteith says:

      Patients are scheduling surgery 3 to 6 weeks from the time they call, schedule, and pay. Call us at (919) 968-4656 8am to 5pm eastern standard time and we would be happy to speak with you.

      The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal

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